This thesis analyzes the influence of specialized cancer hospitals in Florida on the outcomes of the mortality risk, length of stay, and charges of care among patients diagnosed with cancer, and performed a mastectomy, lumpectomy or radical prostatectomy, after controlling for age, gender, race, severity, type of hospital ownership, payment options, type of admission, and presence or absence of residency programs. The Florida Agency for Health Care Administration inpatient hospital discharge dataset of 2005 was used to extract data. Analysis of covariance was used to compute the differences on the three outcomes as a function of the specialization/volume of the treatment facility. The treatment facility categories were defined as (1) specialized cancer hospital; (2) general hospital with high volume (100 or more cancer treatment discharges per defined cancer); (3) general hospital with medium volume (50 to 99 cancer treatment discharges per defined cancer); (4) general hospital with low volume (25 to 49 cancer treatment discharges per defined cancer); and (5) general hospital with very low volume (less than 25 cancer treatment discharges per defined cancer). There were no deaths in any of the three procedures at specialized cancer hospitals. Being hospitalized at a specialty cancer hospital for a radical prostatectomy for prostate cancer was associated with 0.93 fewer days in mean length of stay (mean = 2.68 overall), but length of stay was not significantly different for mastectomy and lumpectomy (mean = 2.21 and 1.86 overall respectively) compared to general hospitals with very low volumes. Charges for care were not significantly different for lumpectomy and radical prostatectomy (mean = $22,097 and $25,220 overall respectively) for a specialty cancer hospital compared to general hospitals with very low volumes, where for mastectomies it was $4,850 on average lower (mean = $24,608 overall). In this study, patients managed at specialized cancer hospitals sometimes had better outcomes (i.e. shorter lengths of stay for radical prostatectomies and lower charges for mastectomies) compared to very low volume hospitals, while not having any significantly worse outcomes.

In recent years, the UK higher education sector has seen notable policy changes with regard to how research is funded, disseminated and evaluated. Important amongst these changes is the emphasis that policy makers have placed on disseminating peer-reviewed scholarly journal articles via Open Access (OA) publishing routes e.g. OA journals or OA repositories. Through the Open Science agenda there have also been a number of initiatives to promote the dissemination of other types of output that have not traditionally been made publicly available via the scholarly communication system, such as data, workflows and methodologies. The UK Research Excellence Framework (REF) 2014 introduced social/economic impact of research as an evaluation measure. This has been a significant policy shift away from academic impact being the sole measure of impact and has arguably raised the profile of public engagement activities (although it should be noted that public engagement is not equivalent to social/economic impact, but is an important pathway to realising such impact). This exploratory study sought to investigate the extent to which these recent policy changes are aligned with researchers publication, dissemination and public engagement practices across different disciplines. Furthermore, it sought to identify the perceptions and attitudes of researchers towards the concept of social/economic impact. The study adopted a mixed-methods approach consisting of a questionnaire- based survey and semi-structured interviews with researchers from a broad range of disciplines across the physical, health, engineering, social sciences, and arts and humanities across fifteen UK universities. The work of Becher (1987) and Becher & Trowler (2001) on disciplinary classification was used as an explanatory framework to understand disciplinary differences. The study found evidence of a lack of awareness of the principle of OA by some researchers across all disciplines; and that researchers, in the main, are not sharing their research data, therefore only the few who are doing so are realising the benefits that have been championed in research funders policies. Moreover, the study uncovered that due to the increased emphasis of impact in research evaluation, conflicting goals between researchers and academic leaders exist. The study found that researchers, particularly from Applied and Interdisciplinary (as opposed to Pure) disciplinary groups felt that research outputs such as articles published in practitioner journals were most appropriate in targeting and making research more accessible to practitioners, than prestigious peer-reviewed scholarly journal articles. The thesis argues that there is still more to learn about what impact means to researchers and how it might be measured. The thesis makes an overall contribution to knowledge on a general level by providing greater understanding of how researchers have responded to the impact agenda . On a more specific level, the thesis identifies the effect of the impact agenda on academic autonomy, and situates this in different disciplinary contexts. It identifies that it is not only researchers from Pure disciplines who feel disadvantaged by the impact agenda , but also those from Interdisciplinary and Applied groups who feel an encroachment on their academic autonomy, particularly in selecting channels to disseminate their research and in selecting the relevant audiences they wish to engage with. Implications of the study s findings on researchers, higher education institutions and research funders are highlighted and recommendations to researchers, academic leaders and research funders are given.

Esse estudo de caso teve como objetivo analisar a estrutura, o processo de trabalho e os resultados do Programa de Transplante de Fígado de um hospital universitário do interior paulista, em 2017. Foram analisados 325 prontuários de pacientes submetidos ao transplante de fígado no período de abril de 2001 a junho de 2016. Elegeu-se as variáveis sociodemográficas, clínicas, de tratamento, de estrutura, de processo e de resultados. Para a coleta de dados foram utilizados três formulários e um diário de campo. Para a análise dos dados quantitativos e qualitativos utilizou-se a abordagem de Avaliação em Saúde proposta por Donabedian (1980), a Resolução de Diretoria Colegiada º 50/2002 e a Portaria º 356/2014. Para o cálculo da sobrevida do paciente utilizou-se o método de Kaplan-Meyer e o Modelo de Regressão de Cox. Para o cálculo da sobrevida do enxerto utilizou-se o método de Kaplan-Meyer e o modelo de Regressão de Riscos Competitivos. Os resultados mostraram que a maioria dos pacientes era homens, adultos de meia idade, com comorbidades prévia, doença hepática moderada ou grave, complicações imediatas e tardias com baixa probabilidade de sobrevida. Quanto a estrutura o Programa atendeu em parte as recomendações para os componentes da estrutura organizacional-física (58,3%), organizacional de recursos humanos (55,6%), estrutural-física para funcionários e alunos (60,0%) e estrutural-física do ambulatório (50,0%). Em relação ao processo de atendimento identificou-se lacunas de documentos e ou diretrizes que norteiam a equipe de saúde no processo de trabalho. No que se refere aos indicadores de resultados, o número de transplantes sofreu alteração devido a fatores extrínsecos e intrínsecos. A maioria dos pacientes permaneceu em lista de espera por até 12 meses. Os pacientes encontravam-se em gravidade moderada a alta e probabilidade de mortalidade de 76%. O tempo de isquemia fria variou de 240 a 970 minutos, média de 499 (±112,0) minutos. A sobrevida do paciente após um, três e cinco anos de transplante foi de 66,4%, 60,4% e 56,5%, respectivamente, e a incidência acumulada para perda do enxerto foi da ordem de 10%. A maioria dos pacientes foi internada ao menos uma vez no primeiro ano após o transplante e os motivos principais foram relacionados a terapia de imunossupressão e as complicações cirúrgicas. Mais da metade (53,6%) dos pacientes estavam em seguimento ambulatorial no Programa e 43,7% evoluíram à óbito. O óbito foi relacionado, em sua maioria, ao choque séptico ou hipovolêmico. Conclui-se que os indicadores encontrados no presente estudo estão, em parte, de acordo com a legislação vigente sobre um Programa de Transplante de Fígado e que os indicadores de resultados precisam ser repensados para o fortalecimento e a consolidação do Programa no hospital estudado / The objective of this study was analyze structure, work process and outcomes of the Liver Transplantation Programme in a teaching hospital in Sao Paulo state\'s interior in 2017. It was analyzed 325 patients\' records which were submitted to liver transplantation from April 2011 to June 2016. Sociodemographic, clinical, treatment, structure, process and outcomes were the variables chosen in this study. Three forms and a field diary were used how strategy to data collection. Qualitative and quantitative data have analyzed using Healthcare Evaluation approach purposed by Donabedian (1980), the Directors\' Collegiate Resolution n. 50/2002 and Ministerial Order n. 356/2014. Kaplan-Meyer method and Cox Regression Model were used to estimate the patient survival rate. Kaplan-Meyer Method and Competing Risks Regression Model were used to calculate the graft survival. Study results showed that most patients were men, mid-aged adults, with previous comorbidities, moderate or severe liver disease, immediate and late complications with survival probability decreased. Regarding structure the Programme reached partially the recommendations of components physical-organizational structure (58.3%), organizational of human resources (55.6%), structural-physical to employers and students (60.0%) and structural-physical of clinic (50.0%). With respect to healthcare process was identified clinicals protocols absences as well as guidelines which should lead the healthcare providers in the working process. Regarding to outcomes indicators, the transplantation numbers suffered changes due intrinsic and extrinsic factors. Most patients remained in waiting list for until 12 months. The patients presented from moderate to high severity and the probability of mortality was 76% for them. The cold ischemic time range was from 240 to 970 minutes, with mean 499 (±112,0) minutes. The patient survival after one, three and five years after transplantation was 66.4%, 60.4%, 56.5%, respectively. The cumulative incidence to loss graft have been 10%. The most patients were hospitalized at least once in the first year after transplantation and the principal causes were related to immunosuppressive therapy and surgical complications. At the end of the study, more than half of patients (53.6%) were in clinical Programme follow-up and 43.7% had died. The most deaths were related with septic or hypovolemic shock. Therefore, is possible conclude that the indicators found in this investigation were, partially, according with Brazilian Current Law recommendations about Liver Transplantation Programs. The outcomes indicators should be rethought to promote strengthening and consolidation of Programme in the Hospital studied

Esse estudo de caso teve como objetivo analisar a estrutura, o processo de trabalho e os resultados do Programa de Transplante de Fígado de um hospital universitário do interior paulista, em 2017. Foram analisados 325 prontuários de pacientes submetidos ao transplante de fígado no período de abril de 2001 a junho de 2016. Elegeu-se as variáveis sociodemográficas, clínicas, de tratamento, de estrutura, de processo e de resultados. Para a coleta de dados foram utilizados três formulários e um diário de campo. Para a análise dos dados quantitativos e qualitativos utilizou-se a abordagem de Avaliação em Saúde proposta por Donabedian (1980), a Resolução de Diretoria Colegiada º 50/2002 e a Portaria º 356/2014. Para o cálculo da sobrevida do paciente utilizou-se o método de Kaplan-Meyer e o Modelo de Regressão de Cox. Para o cálculo da sobrevida do enxerto utilizou-se o método de Kaplan-Meyer e o modelo de Regressão de Riscos Competitivos. Os resultados mostraram que a maioria dos pacientes era homens, adultos de meia idade, com comorbidades prévia, doença hepática moderada ou grave, complicações imediatas e tardias com baixa probabilidade de sobrevida. Quanto a estrutura o Programa atendeu em parte as recomendações para os componentes da estrutura organizacional-física (58,3%), organizacional de recursos humanos (55,6%), estrutural-física para funcionários e alunos (60,0%) e estrutural-física do ambulatório (50,0%). Em relação ao processo de atendimento identificou-se lacunas de documentos e ou diretrizes que norteiam a equipe de saúde no processo de trabalho. No que se refere aos indicadores de resultados, o número de transplantes sofreu alteração devido a fatores extrínsecos e intrínsecos. A maioria dos pacientes permaneceu em lista de espera por até 12 meses. Os pacientes encontravam-se em gravidade moderada a alta e probabilidade de mortalidade de 76%. O tempo de isquemia fria variou de 240 a 970 minutos, média de 499 (±112,0) minutos. A sobrevida do paciente após um, três e cinco anos de transplante foi de 66,4%, 60,4% e 56,5%, respectivamente, e a incidência acumulada para perda do enxerto foi da ordem de 10%. A maioria dos pacientes foi internada ao menos uma vez no primeiro ano após o transplante e os motivos principais foram relacionados a terapia de imunossupressão e as complicações cirúrgicas. Mais da metade (53,6%) dos pacientes estavam em seguimento ambulatorial no Programa e 43,7% evoluíram à óbito. O óbito foi relacionado, em sua maioria, ao choque séptico ou hipovolêmico. Conclui-se que os indicadores encontrados no presente estudo estão, em parte, de acordo com a legislação vigente sobre um Programa de Transplante de Fígado e que os indicadores de resultados precisam ser repensados para o fortalecimento e a consolidação do Programa no hospital estudado / The objective of this study was analyze structure, work process and outcomes of the Liver Transplantation Programme in a teaching hospital in Sao Paulo state\'s interior in 2017. It was analyzed 325 patients\' records which were submitted to liver transplantation from April 2011 to June 2016. Sociodemographic, clinical, treatment, structure, process and outcomes were the variables chosen in this study. Three forms and a field diary were used how strategy to data collection. Qualitative and quantitative data have analyzed using Healthcare Evaluation approach purposed by Donabedian (1980), the Directors\' Collegiate Resolution n. 50/2002 and Ministerial Order n. 356/2014. Kaplan-Meyer method and Cox Regression Model were used to estimate the patient survival rate. Kaplan-Meyer Method and Competing Risks Regression Model were used to calculate the graft survival. Study results showed that most patients were men, mid-aged adults, with previous comorbidities, moderate or severe liver disease, immediate and late complications with survival probability decreased. Regarding structure the Programme reached partially the recommendations of components physical-organizational structure (58.3%), organizational of human resources (55.6%), structural-physical to employers and students (60.0%) and structural-physical of clinic (50.0%). With respect to healthcare process was identified clinicals protocols absences as well as guidelines which should lead the healthcare providers in the working process. Regarding to outcomes indicators, the transplantation numbers suffered changes due intrinsic and extrinsic factors. Most patients remained in waiting list for until 12 months. The patients presented from moderate to high severity and the probability of mortality was 76% for them. The cold ischemic time range was from 240 to 970 minutes, with mean 499 (±112,0) minutes. The patient survival after one, three and five years after transplantation was 66.4%, 60.4%, 56.5%, respectively. The cumulative incidence to loss graft have been 10%. The most patients were hospitalized at least once in the first year after transplantation and the principal causes were related to immunosuppressive therapy and surgical complications. At the end of the study, more than half of patients (53.6%) were in clinical Programme follow-up and 43.7% had died. The most deaths were related with septic or hypovolemic shock. Therefore, is possible conclude that the indicators found in this investigation were, partially, according with Brazilian Current Law recommendations about Liver Transplantation Programs. The outcomes indicators should be rethought to promote strengthening and consolidation of Programme in the Hospital studied

Notre travail s’inscrit dans le cadre des études anglophones de spécialité et a pour objet de contribuer à la caractérisation des pratiques d’évaluation dans le monde de l’enseignement supérieur britannique envisagé comme domaine spécialisé. Notre approche consiste à montrer que l’évaluation institutionnelle des activités des universités, parce qu’elle revêt des formes multiples qui sont propres au domaine de l’enseignement supérieur au Royaume-Uni, constitue un mode privilégié de saisie et de compréhension de la spécificité de ce domaine. Nous établissons, dans un premier temps, un ensemble de points de repère généraux pour notre étude : nous présentons le cadre théorique et méthodologique que nous adoptons, nous dressons un portrait global de l’enseignement supérieur britannique actuel et nous soulignons les caractéristiques fondamentales du processus d’évaluation. Nous caractérisons ensuite les pratiques institutionnelles d’évaluation des établissements d’enseignement supérieur à travers l’organisation et le fonctionnement de leurs dispositifs, les acteurs qui les animent et leurs rapports au sein de l’évaluation et, enfin, une cartographie générale des différents genres de discours produits dans le cadre de l’évaluation. Une dernière partie est consacrée à l’analyse détaillée des discours d’évaluation selon trois axes qui correspondent à trois objets centraux de l’évaluation : la recherche, les diplômes et l’expérience d’apprentissage. A travers l’étude de leurs critères et de leurs résultats d’évaluation, nous analysons l’impact de l’évaluation sur l’identité professionnelle des enseignants-chercheurs, le fonctionnement des universités et, plus globalement, la nature des missions du monde de l’enseignement britannique. / Our research work aims at contributing to the characterization of evaluation practices in the the British higher education sector. It draws on the theoretical and methodological framework of Anglais de spécialité, a disciplinary field focusing on specialized fields in the English-speaking world. This work consists more specifically in showing that the study of evaluation practices represents a particularly interesting way of identifying and analysing the essential characteristics of higher education in the United Kindgom. First, we introduce the theoretical and methodological framework of our study, we draw a global portrait of British higher education today and we underline the essential characteristics of the evaluation process. We then move on to explain how institutional evaluation works in the British higher education sector, who its main actors are and how they interact and how the discourses they produce can be organized into specific genres that relate to the more global category of academic discourse. Finally, we analyse in detail a set of discourses related to the evaluation of three dimensions of higher education in the United Kingdom – research, academic standards and the learning experience. The study of the criteria and results of these dimensions allows us to analyse the impact of evaluation on the professional identity of academics, on the organization of higher education institutions and, more globally, on the missions of the British higher education sector.